Endocrine: Gestational DM

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Author:
jcbarbery
ID:
214862
Filename:
Endocrine: Gestational DM
Updated:
2013-04-21 15:33:43
Tags:
endocrine pregnancy diabetes
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Description:
Overview of gestational diabetes and its treatment.
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  1. Prolactin and human placental lactogen (hPL)
    elevated
    Serotonin production in beta-cells increased

    beta-cell expansion

    beta-cell glucose sensitivity increases

    Insulin secretory capacity increases

    • No changes in alpha-cell mass or glucagon
    • secretion
  2. Inc Progesterone
    -> increased insulin resistance
  3. Glucose Gradient
    • Decreases as gestation progresses
    • -> increased insulin resistance
  4. Risks assoc. w/GDM
    • Pre-eclampsia
    • Birthing large for gestational age (LGA) babies

    • Macrosomia
    • LGA birth
  5. GDM Dx (1 Step)
    Fasting 100g OGTT
  6. GDM Dx (2Step)
    Fasting 50g oral glucose challenge test

    if >/= 130-140 -> Fasting 100g OGTT
  7. Ethnic High Risk Groups
    • AA
    • Asian
    • Hispanic
    • NA
    • PI
  8. Low Risk Criteria
    • Low risk ethnic group
    • < 25 yo
    • No 1st o relative w/DM
    • Pre-pregnancy BMI < 25
    • Normal birth weight
    • No Hx of poor obstetric outcomes
    • No Hx of poor glucose metabolism

    (No test)
  9. High Risk Criteria
    • Severely obese
    • FH of T2DM
    • Hx of GDM

    (test STAT)
  10. Average Risk
    (test @ 24-28 weeks)
  11. GDM Tx
    • Insulin
    • Glyburide (stop 2wks pre-delivery)
    • Metformin
  12. DM Tx during delivery
    • NPH QHS
    • AM dose held -> normal saline infusion

    change to D5W @ <70 or active labor

    1.25 U/h @ >100 (adj. PRN)

    Hourly finger sticks
  13. Infant Hyperinsulinemia
    Occurs @ birth d/t 2nd/3rd trimester poor glucose control

    • Hypokalemia
    • Hypocalcemia
    • Hypomagnesemia
    • Hypoglycemia (<25-40 mg/dL)
  14. Infant Polycythemia
    • Inc. O2 demand d/t inc. catabolism
    • Increased red cell production
    • Hyperbilirubinemia (Inc. red cell turnover)
  15. IDM (infant of diabetic mother) Tx
    D10W 1-2 mL/kg

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